Camden’s Health and Wellbeing Board convened an interesting meeting recently to look at tackling obesity and low levels of physical activity among residents in the borough. We started with presentations (pp 10, 11) on the situation in the borough (a surprising number of the over 65s and primary school age children are overweight). We then worked in groups looking at what we could do. For more background there are some national guidelines on developing local strategies here (warning 250 pages!)
It was good to see the acknowledgement of a deeper role in health at a policy and a planning level. We don’t hear much about the social determinants of health, spanning everything from social and economic factors, the physical environment and policy decisions that are the foundation of good health. We’re used to seeing healthy messages targeted at individual behaviour, but often it’s policy levers influencing social and economic factors and the physical environment that have much bigger effects. In Victorian England, the vast leap in the health of the nation (such as elimination of Cholera, Diphtheria, TB and so on) were all achieved at the policy level by tackling overcrowding, poor sanitation and poverty through a combination of legislation and public infrastructure building.
There’s lot’s that can be still be done at the policy level. Camden has powers over planning, speed limits, catering in schools and institutions, even little things like benches and loos can have a big impact on people’s lives. Ofsted will be looking at measures aimed at physical health and wellbeing in primary schools from 2017. The Mayor is tackling air pollution across London. Transport infrastructure and cycling strategies will impact health and wellbeing too.
The meeting was an opportunity to bring a number of different sectors together. But what were the voluntary sector there for? Hopefully we could contribute knowledge and ideas from the sector – our group spent some time looking at getting people more active and Sofina from KCBNA was able to bring her insights into working with BAME older people and encouraging activity. Our group liked walking and I talked about Kove’s Ageing Better funded bench-to-bench walks in. Kove discovered that a key barrier for older people was a lack of benches. They campaigned for more benches (but not ‘Camden’ benches) and then mapped out routes so that older walkers could have a regular rest. Lack of public loos can also be a barrier to older and disabled people getting out more and the community toilet scheme helps there. For the young the issues seemed to be about risk and safety (for example traffic) and public authorities had a role in creating play streets, lowering speed limits and encouraging walking to school. We thought a bit about how people could be encouraged to be more active and the sort of messages they might respond to. Walking can be made goal oriented with apps and challenges, or a social pastime with social and cultural interest walking groups – different approaches favour different age groups.
We also talked a bit about opportunities to make the most of school kitchens as a resource and involve out-of-hours groups supported by celebrity chef led charities to make the most of these resources to improve healthy eating in the borough. We talked about Rhyll and Mayfield that are working on this and the help that Foundations like Greggs can bring – and we’ve been involved too, helping with fundraising advice to the PTA. By the way, now is a good time to approach the Greggs Foundation as their Manager Jackie Crombie is on secondment to Business in the Community as a Business connector in Camden. With all these connections, there is the potential for lots of good things to happen when public, private and voluntary sector work together on common ends.
Choosing where we think we can have the best impact and then getting the messaging right will be challenging – simple messages work best – think of the 1980s Aids campaign (safe sex!) or smoking (quit!). But food and lifestyle are more complex and less amenable to simple messages ‘Eat a varied diet in moderation’ may be sound advice but it’s hardly likely to capture the public imagination. Fortunately we have onboard media and marketing specialists – The Campaign Company – to help us.
Hopefully the voluntary and community sector will be able to contribute all sorts of knowledge and ideas. For example, we are involved in a social prescribing project where Health Advocates talk to patients in GP waiting rooms and C4 have a related Community Connectors project, both of which are great opportunities to talk to residents about health messages. Of course the others in the room all came up with a huge range of interesting ideas as well, and there is plenty of work still to be done so it’s impossible to predict what the final action plan will look like at this early stage.
However, it’s worth mentioning that there is an unfortunate history of confused nutrition education messaging that has clouded this whole area, and might explain why a maker of sugary drinks can market it as a sports drink for the fit – though only a few years ago the same drink was marketed as a convalescents drink for the sick.
We really have had a bad half century of nutrition advice and public messages. Starting in the 1960 when the humble egg went from hero (go to work on an egg) to villain just ten years later. All because of unscientific links between the presence of cholesterol in the yolk and cholesterol in the brain (good!) and blocking arteries (bad!). Somehow along the way someone forget that there is a both a blood-brain barrier and a gut barrier, so ingredients in food don’t just travel straight into your body. Oh well.
Things got even worse with the fat vs sugar war. Yudkin, the head of department at my alma mater, QEC, wrote ‘Pure White and Deadly’ in 1972 convinced that processed sugar was to blame for the rise in heart disease and obesity. Unfortunately an American, Ancel Keys, thought that saturated fat was to blame and his views were taken up by the powerful American Heart Association. The fat vs sugar war raged briefly but fat soon won out and Yudkin found his career had come to a sudden end. Actually, they were both brilliant scientists working in a tricky field and the blame lies as much with public health needing simple messages as it does with powerful vested interests in the food industry.
Sadly the result of trying to correct these historical errors may well be more anger and confusion. First the myths about fats will have to be tackled both here and in the US. Then the public will have to get used to new facts. This will essentially mean eating a lot less sugar. The US has taken tentative steps and the public in the UK are being softened up for the message that sugar is bad with actions like a soft drinks sugar tax in the 2016 budget. However, a rather alarming backtracking has just occurred in the final draft of the Childhood Obesity Plan, where Theresa May’s government has overseen a dramatic watering down of the original proposals. Perhaps sugar will continue its miraculous charmed life for a bit longer (if any of us are left alive to buy it).
To finish I want to share the new Brazilian dietary guidelines which have taken the revolutionary step of using social messages rather than biomedical messages. What I mean by that is that rather than health messages that talk purely about the components of diet (ie eat more fiber, eat less carbohydrate etc) they have come up with messages that tackle the social aspects of eating, such as where and how you buy, prepare and eat your food. This shift from a biomedical approach to health to a social model could have profound implications in health more widely. I think this is a revolutionary and powerful approach and I’m sure other countries will follow – though interesting to note that these guidelines were very unpopular with industry, who presumably know an effective media campaign when they see one.
The Brazilian guidelines are:
- Prepare meals from staple and fresh foods.
- Use oils, fats, sugar, and salt in moderation.
- Limit consumption of ready-to-consume food and drink products.
- Eat regular meals, paying attention, and in appropriate environments.
- Eat in company whenever possible.
- Buy food at places that offer varieties of fresh foods. Avoid those that mainly sell products ready for consumption.
- Develop, practice, share, and enjoy your skills in food preparation and cooking.
- Plan your time to give meals and eating proper time and space.
- When you eat out, choose restaurants that serve freshly made dishes and meals. Avoid fast food chains.
- Be critical of the commercial advertisement of food products.